I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.

Happy Weekend,

Corri

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 4:10:58 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:47 PM

Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.

____________ _________ _________ __

From: Corri Baker <virtuous_gracious@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:43:20 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:38:50 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:03 PM

Hi Carol,

I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.

I hope I didn't misunderstand you,

Corri :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 2:51:13 PM

Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Hello,

I have a new task at my job. The way my manager explained it is quite confusing.

So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%

I went 56.00 x 4 = 224

Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.

I'd greatly appreciate it! Thanks!

Carol

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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Erika Dennis

Hi, That s a little vague...what did the denial say on the remittance advice? It could be many reasons... Erika D. Mid Ohio Pulmonary & Sleep Assoc, Inc.

Message 2 of 16
, Feb 1, 2010

0 Attachment

Hi,
That's a little vague...what did the denial say on the remittance advice? It could be many reasons...

I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.

Happy Weekend,

Corri

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 4:10:58 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:47 PM

Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.

____________ _________ _________ __

From: Corri Baker <virtuous_gracious@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:43:20 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:38:50 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:03 PM

Hi Carol,

I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.

I hope I didn't misunderstand you,

Corri :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 2:51:13 PM

Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Hello,

I have a new task at my job. The way my manager explained it is quite confusing.

So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%

I went 56.00 x 4 = 224

Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.

I'd greatly appreciate it! Thanks!

Carol

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

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debbie brosnan

In our state (Mi) depending on the carrier we bill this CPT code with a zero dollar amount then the appropiate level E/M all with a place of service 11.

Message 3 of 16
, Feb 1, 2010

0 Attachment

In our state (Mi) depending on the carrier we bill this CPT code with a zero dollar amount then the appropiate level E/M all with a place of service 11. 99058 is just identifing services rendered in urgent care setting. Many payers dont even show this code as a payable service. Blues use an "S" code with the E/M to identify services preformed in an urgent care setting. Hope this helps.

I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.

Happy Weekend,

Corri

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 4:10:58 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:47 PM

Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.

____________ _________ _________ __

From: Corri Baker <virtuous_gracious@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:43:20 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 3:38:50 PM

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.

Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

To: MedicalBillers@ yahoogroups. com

Date: Friday, January 29, 2010, 3:03 PM

Hi Carol,

I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.

I hope I didn't misunderstand you,

Corri :)

____________ _________ _________ __

From: Carol Roush <carollroush@ yahoo.com>

To: MedicalBillers@ yahoogroups. com

Sent: Fri, January 29, 2010 2:51:13 PM

Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

Hello,

I have a new task at my job. The way my manager explained it is quite confusing.

So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%

I went 56.00 x 4 = 224

Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.

--- In MedicalBillers@yahoogroups.com, Corri Baker <virtuous_gracious@...> wrote:
>
> I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
>
> Happy Weekend,
> Corri
>
>
>
>
> ________________________________
> From: Carol Roush <carollroush@...>
> To: MedicalBillers@yahoogroups.com
> Sent: Fri, January 29, 2010 4:10:58 PM
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
>
> Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
>
> Thanks for the help,
>
> Carol
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
> To: MedicalBillers@ yahoogroups. com
> Date: Friday, January 29, 2010, 3:47 PM
>
>
>
> Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
>
> ____________ _________ _________ __
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:43:20 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:38:50 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:03 PM
>
> Hi Carol,
>
> I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
>
> I hope I didn't misunderstand you,
>
> Corri :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 2:51:13 PM
>
> Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Hello,
>
> I have a new task at my job. The way my manager explained it is quite confusing.
>
> So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
>
> I went 56.00 x 4 = 224
>
> Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
>
> I'd greatly appreciate it! Thanks!
>
> Carol
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
>
>
>
>
>
>
> [Non-text portions of this message have been removed]
>

Melinda

It must be billed in addition to basic service (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language. Hope that

Message 5 of 16
, Feb 1, 2010

0 Attachment

It must be billed "in addition to basic service" (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language.

Hope that helps!

Melinda Brown, CMBS
Ins Biller

--- In MedicalBillers@yahoogroups.com, fami tab <marmar623@...> wrote:
>
> Hello Everyone,
>
> Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
> Any advised?
> Appreciated,
> Thanks,
>
> Urgent Care Office Visit 99058
>
>
>
>
> ________________________________
> From: Carol Roush <carollroush@...>
> To: MedicalBillers@yahoogroups.com
> Sent: Fri, January 29, 2010 4:56:09 PM
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
>
> the CPT code we use to bill speech therapy is 92507.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
> To: MedicalBillers@ yahoogroups. com
> Date: Friday, January 29, 2010, 4:20 PM
>
>
>
> I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
>
> Happy Weekend,
>
> Corri
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 4:10:58 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
>
> Thanks for the help,
>
> Carol
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:47 PM
>
> Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
>
> ____________ _________ _________ __
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:43:20 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:38:50 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:03 PM
>
> Hi Carol,
>
> I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
>
> I hope I didn't misunderstand you,
>
> Corri :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 2:51:13 PM
>
> Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Hello,
>
> I have a new task at my job. The way my manager explained it is quite confusing.
>
> So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
>
> I went 56.00 x 4 = 224
>
> Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
>
> I'd greatly appreciate it! Thanks!
>
> Carol
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
>
>
>
>
>
>
> [Non-text portions of this message have been removed]
>

djgeisel

To take off on this...the fifth visit will have $26 left to the deductible so collect $26 plus the remaining amount of $30 you charge 10% which is 3.00 so all

Message 6 of 16
, Feb 1, 2010

0 Attachment

To take off on this...the fifth visit will have $26 left to the deductible so collect $26 plus the remaining amount of $30 you charge 10% which is 3.00 so all together on the 5th visit charge the patient 29.00.($26.00 + $3.00) On the next visit $5.60 is 10% of the approved amount and that is of course what you would collect since now the deductible is met.
Diana

--- In MedicalBillers@yahoogroups.com, fami tab <marmar623@...> wrote:
>
> Good evening Everyone,
> Please correct me if I am wrong.
>
>
>
>
> Contract rate is $56.00
> 90% of 56 is $50.40
> 10% of 56 $5.60
>
> 250 divided by 50.40 is 4.96, almost 5, the first 5 visits are going towards deductable.
>
> Fami
>
>
>
> ________________________________
> From: Carol Roush <carollroush@...>
> To: MedicalBillers@yahoogroups.com
> Sent: Fri, January 29, 2010 4:56:09 PM
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
>
> the CPT code we use to bill speech therapy is 92507.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
> To: MedicalBillers@ yahoogroups. com
> Date: Friday, January 29, 2010, 4:20 PM
>
>
>
> I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
>
> Happy Weekend,
>
> Corri
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 4:10:58 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
>
> Thanks for the help,
>
> Carol
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:47 PM
>
> Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
>
> ____________ _________ _________ __
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:43:20 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:38:50 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:03 PM
>
> Hi Carol,
>
> I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
>
> I hope I didn't misunderstand you,
>
> Corri :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 2:51:13 PM
>
> Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Hello,
>
> I have a new task at my job. The way my manager explained it is quite confusing.
>
> So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
>
> I went 56.00 x 4 = 224
>
> Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
>
> I'd greatly appreciate it! Thanks!
>
> Carol
>
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It must be billed "in addition to basic service" (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language.

Hope that helps!

Melinda Brown, CMBS
Ins Biller

--- In MedicalBillers@ yahoogroups. com, fami tab <marmar623@. ..> wrote:
>
> Hello Everyone,
>
> Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
> Any advised?
> Appreciated,
> Thanks,
>
> Urgent Care Office Visit 99058
>
>
>
>
> ____________ _________ _________ __
> From: Carol Roush <carollroush@ ...>
> To: MedicalBillers@ yahoogroups. com
> Sent: Fri, January 29, 2010 4:56:09 PM
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
>
> the CPT code we use to bill speech therapy is 92507.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
> To: MedicalBillers@ yahoogroups. com
> Date: Friday, January 29, 2010, 4:20 PM
>
>
>
> I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
>
> Happy Weekend,
>
> Corri
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 4:10:58 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
>
> Thanks for the help,
>
> Carol
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:47 PM
>
> Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
>
> ____________ _________ _________ __
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:43:20 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 3:38:50 PM
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
>
> --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
>
> From: Corri Baker <virtuous_gracious@ yahoo.com>
>
> Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> To: MedicalBillers@ yahoogroups. com
>
> Date: Friday, January 29, 2010, 3:03 PM
>
> Hi Carol,
>
> I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
>
> I hope I didn't misunderstand you,
>
> Corri :)
>
> ____________ _________ _________ __
>
> From: Carol Roush <carollroush@ yahoo.com>
>
> To: MedicalBillers@ yahoogroups. com
>
> Sent: Fri, January 29, 2010 2:51:13 PM
>
> Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
>
> Hello,
>
> I have a new task at my job. The way my manager explained it is quite confusing.
>
> So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
>
> I went 56.00 x 4 = 224
>
> Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
>
> I'd greatly appreciate it! Thanks!
>
> Carol
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
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